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Antitissue Transglutaminase Normalization Postdiagnosis in Children With Celiac Disease
Daniela Migliarese Isaac1, Seema Rajani, Maryna Yaskina
1*Department of Pediatric Gastroenterology and Nutrition †Department of Pediatrics, Faculty of Medicine and Dentistry ‡Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada.
Insights
Pediatric celiac disease patients with higher baseline antitissue transglutaminase (atTG) or type 1 diabetes mellitus (T1DM) took longer to normalize atTG levels. Gluten-free diet compliance significantly predicted earlier atTG normalization.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Endocrinology
Background:
- Celiac disease (CD) diagnosis in children requires monitoring of serological markers like antitissue transglutaminase (atTG).
- Limited data exist on the time trends and predictors of atTG normalization in pediatric CD patients.
Purpose of the Study:
- To evaluate the time to normalization of atTG levels in children diagnosed with CD.
- To identify independent predictors influencing the duration of atTG normalization.
Main Methods:
- Retrospective chart review of 487 pediatric CD patients diagnosed between 2007-2014.
- Kaplan-Meier analysis for time to atTG normalization and Cox regression for predictor assessment.
- Assessed predictors included initial atTG, Marsh score, gluten-free diet compliance (GFDC), age, sex, comorbidities (e.g., T1DM), and family history.
Main Results:
- Approximately 80.5% of patients achieved atTG normalization, with a median time of 407 days.
- Gluten-free diet compliant patients normalized faster (median 364 days).
- Patients with Type 1 Diabetes Mellitus (T1DM) showed significantly longer normalization times (1204 days). Higher baseline atTG and T1DM were predictors of longer normalization time, while GFDC predicted earlier normalization.
Conclusions:
- Gluten-free diet compliance and lower baseline atTG levels predict faster atTG normalization in pediatric CD.
- Children with T1DM experience prolonged atTG normalization, necessitating targeted research and education for this high-risk group.
Objectives:
Limited pediatric data exist examining the trend and predictors of antitissue transglutaminase (atTG) normalization over time in children with celiac disease (CD). We aimed to evaluate time to normalization of atTG in children after CD diagnosis, and to assess for independent predictors affecting this duration.
Methods:
A retrospective chart review was completed in pediatric patients with CD diagnosed from 2007 to 2014 at the Stollery Children's Hospital Celiac Clinic (Edmonton, Alberta, Canada). The clinical predictors assessed for impact on time to atTG normalization were initial atTG, Marsh score at diagnosis, gluten-free diet compliance (GFDC), age at diagnosis, sex, ethnicity, medical comorbidities, and family history of CD. Kaplan-Meier survival analysis was completed to assess time to atTG normalization, and Cox regression to assess for independent predictors of this time.
Results:
A total of 487 patients met inclusion criteria. Approximately 80.5% of patients normalized atTG levels. Median normalization time was 407 days for all patients (95% confidence interval [CI: 361-453]), and 364 days for gluten-free diet compliant patients (95% CI [335-393]). Type 1 diabetes mellitus (T1DM) patients took significantly longer to normalize at 1204 days (95% CI [199-2209], P < 0.001). Cox regression demonstrated T1DM (hazard ratio = 0.36 [0.24-0.55], P < 0.001) and higher baseline atTG (hazard ratio = 0.52 [0.43-0.63], P < 0.001) were significant predictors of longer atTG normalization time. GFDC was a significant predictor of earlier normalization (OR = 13.91 [7.86-24.62], P < 0.001).
Conclusions:
GFDC and lower atTG at diagnosis are predictors of earlier normalization. Patients with T1DM are less likely to normalize atTG levels, with longer normalization time. Additional research and education for higher-risk populations are needed.
